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Musculoskeletal > Lower Limb > Flashcards

Lower Limb Flashcards

1
Q

List the innominate hip bones

A
  1. Ilium
  2. Pubis
  3. Ischium
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2
Q

What cartilage unites the hip bones at the acetabulum in infants

A

Triradiate cartilage

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3
Q

List the bones of the pelvic girdle

A
  1. Ilium
  2. Pubis
  3. Ischium
  4. Sacrum
  5. Coccyx
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4
Q

What structures are attached to the ASIS

A
  • Inguinal ligament

- Sartorius

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5
Q

What structure is attached to the iliac fossa

A

Iliacus

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6
Q

List the components of the pubis

A
  1. Body
  2. Superior ramus
  3. Inferior ramus
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7
Q

What structures are attached to the inferior pubic ramus

A
  • Adductors
  • Perineal muscles
  • Perineal membrane
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8
Q

List the components of the ischium

A
  1. Superior ischial ramus
  2. Body of ischium
  3. Inferior ischial ramus
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9
Q

Where is the ischial spine situated

A

Posterior border of the body of the ischium (separates greater and lesser sciatic notch)

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10
Q

What structures attach to the ischial tuberosity and lower body of ischium

A
  • Hamstrings

- Short external rotators (except piriformis)

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11
Q

Number of vertebrae forming the sacrum

A

5

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12
Q

What comprises the anterior aspect of the sacrum

A
  • Central mass
  • Row of four anterior sacral foramina
  • Lateral mass
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13
Q

What muscles attach to the sacrum and where

A
  • Piriformis = originates from S2-4 of the anterior surface
  • Coccygeus = inserts on the lower sacrum
  • Iliacus = primarily arises from iliac fossa but also has fibres originating from the ala of the sacrum
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14
Q

What separates the greater and lesser pelvis

A

Oblique plane of the pelvic inlet = pelvic brim

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15
Q

Borders of the pelvic brim

A
  • Posterior = sacral promontory and sacral wings (ala)
  • Lateral = arcuate line of ileum, pectineal line on superior pubic ramus
  • Anterior = pubic symphysis
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16
Q

What forms the pubic arch

A

Ischiopubic rami (conjoined inferior rami of pubis and ischium) and pubic symphysis

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17
Q

Borders of the pelvic outlet

A
  • Posterior = tip of coccyx
  • Lateral = ischial tuberosities and inferior margin of sacrotuberous ligament
  • Anterior = pubic arch
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18
Q

What ligaments support the symphysis pubis

A
  • Superior pubic ligament

- Inferior pubic ligament

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19
Q

What type of joint is the pubic symphysis

A

Secondary cartilaginous joint

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20
Q

What type of joint is the Sacroiliac joint

A

Diarthrodial synovial joint

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21
Q

List the ligaments of the sacroiliac joint

A
  1. Posterior sacroiliac
  2. Ilio-lumbar
  3. Sacro-tuberous
  4. Sacrospinous
  5. Anterior sacroiliac
  6. Interosseous sacroiliac
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22
Q

Attachments of the ilio-lumbar ligaments

A

Transverse processes of L5 and iliac crests

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23
Q

Attachments of the sacro-tuberous ligaments

A

Ischial tuberosity to sacrum and coccyx

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24
Q

Attachments of sacrospinous ligament

A

Lateral sacrum and coccyx to ischial spine (divides sciatic foramen)

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25
Q

Attachments of the interosseous sacroiliac ligaments

A

Lies deep between the tuberosities of the sacrum and ileum

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26
Q

Posterior relations of the pubic symphysis

A
  • Urethra

- Deep dorsal vein of penis

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27
Q

Orientation of the femoral head

A

Upward, medial and anterior

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28
Q

Where does the ligamentum teres insert

A

Central fovea of the femoral head

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29
Q

Angle of the femoral neck

A

125 degrees (less in females)

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30
Q

Length of femoral neck

A

5cm

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31
Q

Length of femur

A

45cm

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32
Q

What marks the junction between femoral neck and shaft

A
  • Anterior = intertrochanteric line
  • Lateral = GT
  • Medial and posterior = LT
  • Posterior = trochanteric crest
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33
Q

Where is the linea aspera situated

A

Posterior middle 1/3rd of femur

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34
Q

What does the linea aspera split into superiorly

A
  • Medial = pectineal line

- Lateral = gluteal tuberosity

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35
Q

What does the linea aspera split into inferiorly

A

Medial and lateral supracondylar ridges

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36
Q

How does the medial supracondylar ridge end

A

Adductor tubercle

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37
Q

Which of the femoral condyles is more prominent and why

A

Lateral - prevents lateral displacement of the patella

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38
Q

Outline the blood supply of the femoral head

A
  1. Retinacular vessels (from medial circumflex artery from deep femoral)
  2. Ligamentum teres (from obturator)
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39
Q

What causes significant bleeding on femoral shaft fractures

A

Perforating branches of profunda femoris

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40
Q

What can cause bleeding in supracondylar femoral fractures

A

Popliteal artery

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41
Q

What type of bone is the patella

A

Sesamoid bone

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42
Q

Which facet of the patella is larger

A

Lateral

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43
Q

Describe the proximal tibia

A
  • Expanded medial and lateral condyles (medial largest)

- Intercondylar eminence

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44
Q

Cross-sectional shape of tibia

A

Triangular

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45
Q

Where is the soleal line situated

A

Upper end of posterior surface of tibia

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46
Q

What forms a groove on the posterior aspect of the medial malleolus

A

Tendon of tibialis posterior

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47
Q

What forms a groove on the posterior aspect of the lateral malleolus

A

Tendons of:

  • Peroneus longus
  • Peroneus brevis
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48
Q

What structure is at risk from damage to the neck of the fibula

A

Common peroneal nerve

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49
Q

List the bones forming the proximal row of tarsal bones

A
  1. Talus
  2. Navicular
  3. Calcaneum
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50
Q

List the bones forming the distal row of tarsal bones

A
  1. Cuboid (laterally)

2. Three cuneiforms

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51
Q

Describe the shape of the upper border of the talus

A

Widest at the front to give greatest stability in dorsiflexion

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52
Q

What forms a groove on the posterior surface of the talus

A

Tendon for flexor hallucis longus

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53
Q

Describe the posterior surface of the calcaneus

A
  • Middle = roughened for insertion of calcaneal tendon
  • Upper = smooth where bursa between calcaneal tendon and bone lies
  • Lower = covered with fibro-fatty pad of the heel
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54
Q

List the articulations of the calcaneus

A
  1. Superior = talus

2. Anterior = cuboid

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55
Q

List the articulations of the navicular

A
  1. Posterior = talus

2. Anterior = 3 cuneiforms

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56
Q

What muscle inserts into the navicular tuberosity

A

Tibialis posterior

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57
Q

Describe the course of the spring ligament

A

Susternaculum tali of the calcaneum to the tuberosityof the navicular

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58
Q

What travels in the groove on the undersurface of the cuboid

A

Peroneus longus tendon

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59
Q

What forms the transverse arch of the foot

A
  • Border of anterior tarsus and posterior metatarsus

- Cuneiforms narrow inferiorly to give the shape of the arch

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60
Q

What forms the lateral component of the longitudinal arch of the foot

A
  • Posterior calcaneum
  • Cuboid
  • Lateral 2 metatarsal bones
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61
Q

What forms the medial component of the longitudinal arch of the foot

A
  • Posterior calcaneum
  • Head of talus (summit)
  • Navicular
  • 3 cuneiforms
  • Medial 3 metatarsal bones
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62
Q

Name of deep fascia of the thigh

A

Fascia lata

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63
Q

Superior connections of the Fascia lata

A
  • Inguinal ligament/pubic arch/body of pubis/pubic tubercle
  • Iliac crest
  • Sacrum/coccyx/sacrotuberous ligament/ischial tuberosity/ischiopubic ramus
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64
Q

What is the Fascia lata continuous with superiorly

A

Scarpa’s fascia of the anterolateral abdominal wall (at a fingers width below the inguinal ligament)

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65
Q

What forms the iliotibial tract

A

Shared aponeurosis of the tensor fascia lata and gluteus maximus muscles (extends from iliac tubercle to anterolateral tubercle of tibia)

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66
Q

Where do the intermuscular septum insert in the leg

A

Linea aspera

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67
Q

List the muscles of the medial compartment of the thigh

A
  • Obturator externus
  • Adductor magnus
  • Adductor brevis
  • Adductor longus
  • Pectineus
  • Gracilis
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68
Q

List the muscles of the anterior compartment fo the thigh

A
  • Vastus medialis
  • Vastus intermedius
  • Vastus lateralis
  • Rectus femoris
  • Sartorius
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69
Q

List the muscles of the posterior compartment of the thigh

A
  • Semitendinosus
  • Semimembranosus
  • Biceps femoris
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70
Q

Where is the saphenous opening

A
  • Within the fascia lata
  • 4cm inferolateral to the pubic tubercle
  • Superior margin is formed by the falciform margin
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71
Q

Contents of the saphenous opening

A
  • Great saphenous vein

- Superficial inguinal nodes

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72
Q

What artery and nerve supply the anterior compartment of the leg

A
  • Deep peroneal nerve

- Anterior tibial artery

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73
Q

List the muscles of the anterior compartment of the leg

A
  • Tibialis anterior
  • Extensor hallucis longus
  • Extensor digitorum longus
  • Peroneus tertius
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74
Q

What artery and nerve supply the lateral compartment of the leg

A
  • Superficial peroneal nerve

- Peroneal artery

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75
Q

List the muscles of the lateral compartment of the leg

A
  • Peroneus longus

- Peroneus brevis

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76
Q

What artery and nerve supply the posterior compartment of the leg

A
  • Tibial nerve

- Posterior tibial artery

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77
Q

What separates the posterior compartment of the leg into deep and superficial plantarflexor muscles

A

Transverse intermuscular septum

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78
Q

List the deep plantarflexors of the posterior compartment

A
  • Flexor hallucis longus
  • Flexor digitalis longus
  • Tibialis posterior
  • Popliteus
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79
Q

List the superficial plantarflexors of the posterior compartment

A
  • Gastrocnemius
  • Soleus
  • Plantaris
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80
Q

What artery and nerve supply the anterior compartment of the thigh

A
  • Femoral artery

- Femoral nerve

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81
Q

What artery and nerve supply the medial compartment of the thigh

A
  • Obturator nerve

- Profunda femoris artery and obturator artery

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82
Q

What artery and nerve supply the posterior compartment of the thigh

A
  • Sciatic nerve

- Branches of profunda femoris artery

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83
Q

Pectineus OIIA

A 
O = Superior ramus of pubis 
I = Pectineal line of femur 
I = Femoral nerve (L2/3)
A = adducts and flexes thigh, assists MR
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84
Q

Psoas Major OIIA

A 
O = Sides of T12-L5
I = Lesser trochanter 
I = Anterior rami of lumbar nerves (L2-3)
A = flexes hip
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85
Q

Psoas Minor OIIA

A 
O = Sides of T12-L1
I = Pectineal line/Iliopectineal eminence 
I = Anterior rami of lumbar nerves (L1/2)
A = flexes hip
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86
Q

Iliacus OIIA

A 
O = iliac crest/iliac fossa/ala/anterior sacro-iliac ligaments 
I = tendon of psoas major/lesser trochanter 
I = Femoral nerve (L1/2) 
A = flexes hip
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87
Q

Sartorius OIIA

A 
O = ASIS 
I = medial surface of tibia 
I = femoral nerve (L2/3) 
A = Flexes, abducts, LR hip
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88
Q

Insertion of all knee extensors

A

Quadriceps tendon

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89
Q

Innervation of all knee extensors

A

Femoral nerve (L2/3/4)

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90
Q

Origin of Rectus Femoris

A
  • AIIS

- Ileum superior to acetabulum

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91
Q

Origin of Vastus Lateralis

A
  • GT

- Lateral linea aspera

92
Q

Origin of Vastus Medialis

A
  • Intertrochanteric line

- Medial linea aspera

93
Q

Origin of Vastus Intermedius

A

Anterior and lateral surfaces of femoral shaft

94
Q

What muscle lies deep to Rectus femoris

A

Vastus intermedius

95
Q

Which is the largest of the vastus muscles

A

Lateralis

96
Q

Function of Articularis Genu

A

Prevents folding of the knee’s synovial membrane and hence keeps it out of the patellofemoral joint

97
Q

Adductor Longus OIIA

A 
O = body of pubis 
I = middle 1/3rd linea aspera 
I = obturator nerve (anterior division)
A = Adducts thigh
98
Q

Adductor Brevis OIIA

A 
O = body and inferior ramus of pubis 
I = pectineal line and proximal linea aspera 
I = obturator nerve (anterior division)
A = adducts thigh, some flexion
99
Q

How can Adductor magnus be divided

A
  • Adductor part

- Hamstring part

100
Q

Adductor Magnus Adductor Part OIIA

A 
O = Inferior ramus of pubis and ischium
I = gluteal tuberosity/linea aspera/medial supracondylar line 
I = obturator nerve (posterior division) 
A = adducts and flexes thigh
101
Q

Adductor Magnus Hamstring Part OIIA

A 
O = Ischial tuberosity 
I = Adductor tuberlce of femur 
I = Tibial part of sciatic nerve (L4)
A = extends thigh
102
Q

Gracilis OIIA

A 
O = body and inferior ramus of pubis 
I = superior part of medial tibial surface 
I = obturator nerve 
A = adducts thigh/flexes leg/MR leg
103
Q

Obturator externus OIIA

A 
O = margins of obturator foramen and membrane 
I = trochanteric fossa of femur 
I = obturator nerve (L3/4)
A = LR thigh/steadies head of femur in acetabulum
104
Q

General origin of adductors

A

Anterior-inferior surface of the bony pelvis (pubic bone, ischiopubic ramus, ischial tuberosity)

105
Q

Most anterior adductor

A

Adductor longus

106
Q

Largest adductor

A

Adductor magnus

107
Q

Most medial adductor

A

Gracilis

108
Q

Which muscles insert into Pes anserinus

A
  1. Gracilis
  2. Sartorius
  3. Semitendinosus
109
Q

Where is the adductor hiatus situated

A

Superior and lateral to adductor tubercle between:

  • Distal adductor part of adductor magnus
  • Tendinous distal attachment of adductor magnus
110
Q

Contents of the adductor hiatus

A
  • Femoral artery
  • Femoral vein
  • Saphenous nerve
111
Q

List the deep (short) external rotators of the hip

A
  • Piriformis
  • Obturator internus
  • Superior gemilli
  • Inferior gemilli
  • Quadratus femoris
112
Q

What overlies the short external rotators

A

Inferior half of gluteus maximus

113
Q

What is the general distal insertion of the short external rotators

A

On or adjacent to the intertrochanteric crest

114
Q

Gluteus maximus OIIA

A 
O = ilium/dorsal sacrum and coccyx/sacrotuberous ligament 
I = Iliotibial tract and gluteal tuberosity 
I = Inferior gluteal nerve (L5/S1)
A = extends thigh and assists with LR
115
Q

Gluteus medius OIIA

A 
O = External surface of ileum
I = lateral surface of GT 
I = superior gluteal nerve (L5/S1) 
A = abduct and MR thigh
116
Q

Gluteus minimus OIIA

A 
O = external surface of ileum 
I = lateral surface of GT 
I = superior gluteal nerve 
A = abduct and MR thigh
117
Q

Tensor fascia latae OIIA

A 
O = ASIS/anterior iliac crest 
I = iliotibial tract 
I = superior gluteal nerve 
A = tenses fascia lata
118
Q

Piriformis OIIA

A 
O = anterior surface of sacrum/sacrotuberous ligament 
I = superior border of GT 
I = branches of anterior rami of S1/2
A = LR thigh
119
Q

Obturator internus OIIA

A 
O = pelvic surface of obturator membrane 
I = medial surface of GT
I = nerve to obturator internus (L5/S1) 
A = LR thigh
120
Q

Superior gemelli OIIA

A 
O = ischial spine 
I = medial surface of GT
I = nerve to obturator internus 
A = LR thigh
121
Q

Inferior gemilli OIIA

A 
O = ischial tuberosity 
I = medial surface of GT 
I = nerve to quadratus femoris 
A = LR thigh
122
Q

Quadratus femoris OIIA

A 
O = lateral border of ischial tuberosity 
I = quadrate tubercle on internal trochanteric crest 
I = nerve to quadratus femoris 
A = LR thigh
123
Q

Where does piriformis exit the pelvis

A

Greater sciatic foramen

124
Q

Damage to which nerve causes a Trendelenberg gait

A

Superior gluteal nerve

125
Q

Superior and inferior relations of piriformis

A
  • Superior = superior gluteal vessels

- Inferior = inferior gluteal vessels, sciatic nerve, posterior cutaneous nerves of thigh

126
Q

Bounds of the greater sciatic foramen

A
  • Anterolateral = greater sciatic notch of ilium
  • Posteromedial = sacrotuberous ligament
  • Inferior = sacrospinous ligament and ischial spine
  • Superior = anterior sacroiliac ligament
127
Q

Nerves of the greater sciatic foramen

A
  • Sciatic nerve
  • Superior and inferior gluteal nerves
  • Pudendal nerve
  • Posterior femoral cutaneous nerve
  • Nerve to quadratus femoris
  • Nerve to obturator internus
128
Q

Vessels of the greater sciatic foramen

A
  • Superior gluteal artery and vein
  • Inferior gluteal artery and vein
  • Internal pudendal artery and vein
129
Q

Contents of the lesser sciatic foramen

A
  • Tendon of obturator internus
  • Pudendal nerve
  • Internal pudendal artery and vein
  • Nerve to obturator internus
130
Q

What structures pass through both greater and lesser foramen

A
  • Pudendal nerve
  • Internal pudendal artery
  • Nerve to obturator internus
131
Q

Semitendinosus OIIA

A 
O = ischial tuberosity 
I = pes anserinus 
I = tibial division of sciatic nerve (L5-S2) 
A = extends thigh/flexes leg/MR when knee flexed
132
Q

Semimembranosus OIIA

A 
O = ischial tuberosity 
I = posterior part of medial condyle of tibia 
I = tibial division of sciatic nerve (L5-S2) 
A = extends thigh/flexes leg/MR when knee flexed
133
Q

Biceps femoris long head OIIA

A 
O = ischial tuberosity 
I = lateral side of head of fibula 
I = tibial division of sciatic nerve 
A = flexes leg/LR when knee flexed/extends thigh
134
Q

Biceps femoris short head OIIA

A 
O = linea aspera 
I = lateral side of head of fibula 
I = common fibular division of sciatic nerve 
A = flexes leg/LR when knee flexed/extends thigh
135
Q

Tibialis anterior OIIA

A 
O = lateral condyle of tibia and IO membrane 
I = medial cuneiform and base of 1st metatarsal 
I = deep peroneal nerve (L4/5)
A = dorsiflexion/inversion
136
Q

Extensor digitorum longus OIIA

A 
O = lateral condyle to tibia and IO membrane 
I = middle and distal phalanges of lateral 4 digits 
I = deep peroneal nerve (L4/5) 
A = extends lateral 4 digits/dorsiflexion
137
Q

Extensor hallucis longus OIIA

A 
O = anterior fibula and IO membrane 
I = dorsal aspect of base of distal phalanx of hallux 
I = deep peroneal nerve (L4/5) 
A = extends great toe/dorsiflexion
138
Q

Peroneus tertius OIIA

A 
O = inferior 1/3rd anterior fibula and IO membrane 
I = dorsum of base of 5th metatarsal
I = deep peroneal nerve (L4/5) 
A = dorsiflexion/eversion
139
Q

Peroneus longus OIIA

A 
O = head of lateral fibula 
I = base of 1st metatarsal and medial cuneiform 
I = superficial peroneal nerve (L5-S2) 
A = eversion/weak plantarflexion
140
Q

Peroneus brevis OIIA

A 
O = inferior 2/3rd of lateral fibula 
I = lateral tuberosity of base of 5th metatarsal 
I = superficial peroneal nerve
A = eversion/weak plantarflexion
141
Q

Common insertion of posterior compartment superficial plantarflexors

A

Posterior surface of calcaneus via calcaneal tendon

142
Q

Origin of gastrocnemius

A
  • Lateral head = lateral aspect of lateral femoral condyle

Medial head = popliteal surface of femur, superior to medial condyle

143
Q

Origin of soleus

A

Posterior aspect of head of fibula/soleal line/middle 1/3rd of medial border of tibia

144
Q

Origin of plantaris

A

Inferior end of lateral supracondular line of femur/oblique popliteal ligament

145
Q

Popliteus OIIA

A 
O = lateral femoral condyle and lateral mensicus 
I = posterior surface of tibia 
I = tibial nerve (L4-S1)
A = weakly flexes knee/unlocks knee
146
Q

Flexor hallucis longus OIIA

A 
O = inferior 2/3rd of posterior fibula and IO membrane
I = base of distal phalnx of great toe 
I = tibial nerve (S2/3)
A = flexes great toe/plantarflexion/support medial longitudinal arch
147
Q

Flexor digitorum longus OIIA

A 
O = posterior surface of tibia by broad tendon to fibula 
I = base of distal phalanges of lateral 4 digits
I = tibial nerve (S2/3) 
A = flexes lateral 4 digits/plantarflexion/supports longitudinal arches
148
Q

Tibialis posterior OIIA

A 
O = IO membrane/posterior surface of tibia/posterior fibula 
I = Navicular tuberosity/cuneiforms/cuboid/calcaneus/base of 2-4th metatarsals 
I = Tibial nerve (L4/5) 
A = plantarflexion/inversion
149
Q

List the muscles attached to the linea aspera

A
  • Vastus lateralis
  • Vastus medius
  • Adductor magnus
  • Adductor longus
  • Adductor brevis
  • Short head of biceps
150
Q

What structures pass posterior to the medial malleolus

A
  • Tibialis posterior tendon
  • Flexor digitorum longus tendon
  • Posterior tibial artery
  • Tibial nerve
  • Flexor hallucis longus tendon
151
Q

Bounds of the femoral triangle

A
  • Above = inguinal ligament
  • Medial = medial border of adductor longus
  • Lateral = lateral border of sartorius
  • Floor = iliopsoas/pectineus
  • Roof = skin/superficial fascia/superficial inguinal lymph/great saphenous vein/fascia lata
152
Q

List the compartments of the retro-inguinal space

A
  1. Muscular (lateral)

2. Vascular

153
Q

Contents of the muscular compartment of the retro-inguinal space

A
  • Psoas muscle

- Femoral nerve

154
Q

Contents of the vascular compartment of the retro-inguinal space

A
  • Femoral artery
  • Femoral vein
  • Deep inguinal lymph nodes
    (All surrounded by femoral sheath)
155
Q

Contents of the femoral triangle from lateral to medial

A
  • Femoral nerve
  • Femoral artery
  • Femoral vein and its proximal tributaries (e.g. great saphenous)
  • Deep inguinal lymph nodes
156
Q

Length of femoral sheath

A

3-4cm

157
Q

Origin of the femoral sheath

A

Inferior prolongation of transversalis and iliopsoas fascia

158
Q

List the 3 compartments and their contents of the femoral sheath

A
  1. Lateral = femoral artery
  2. Intermediate = femoral vein
  3. Medial = femoral canal
159
Q

Course of adductor (Hunter’s canal)

A

Apex of femoral triangle to popliteal fossa

160
Q

Anatomical relations of the adductor canal

A
  • Posterior = adductor longus and magnus
  • Anteromedial = sartorius (forms roof of canal)
  • Anterolateral = vastus medialis
161
Q

Contents of the adductor canal

A
  • Femoral artery
  • Femoral vein (behind the artery)
  • Saphenous nerve
162
Q

Bounds of the popliteal fossa

A
  • Superomedial = semimembranosus
  • Superolateral = biceps femoris tendon
  • Inferolateral = lateral head of gastrocnemius
  • Inferomedial = medial head of gastrocnemius
163
Q

Floor of the popliteal fossa

A

Popliteal surface of femur, posterior ligament of knee, poplitues

164
Q

What is the most superficial structure in the popliteal fossa

A

Tibial nerve (bisects the fossa)

165
Q

What is the deepest structure of in the popliteal fossa

A

Popliteal artery

166
Q

List the contents of the popliteal fossa

A
  • Popliteal artery and vein
  • Small saphenous vein
  • Common peroneal nerve
  • Tibial nerve
  • Posterior cutaneous nerve of thigh
  • Genicular branch of obturator nerve
  • Lymph nodes
167
Q

Structures posterior to lateral malleolus and deep to superficial peroneal retinaculum

A
  • Peroneus longus tendon

- Peroneus brevis tendon

168
Q

Structures posterior to lateral malleolus and superficial to superficial peroneal retinaculum

A
  • Sural nerve

- Short saphenous vein

169
Q

Origin of superior and inferior gluteal arteries

A

Internal iliac

170
Q

Distribution of superior gluteal artery

A
  • Superficial branch = gluteus maximus and skin over its proximal attachment.
  • Deep branch = gluteus medius, gluteus minimus, TFL
171
Q

Distribution of inferior gluteal artery

A
  • Gluteus maximus
  • Obturator internus
  • Quadratus femoris
  • Superior hamstrings
172
Q

Origin of the internal pudendal artery

A

Internal iliac artery

173
Q

Describe the course of the internal pudendal artery

A
  • Lies anterior to inferior gluteal artery
  • Parallels the course of the pudendal nerve
  • Enters thigh via greater sciatic foramen inferior to piriformis
  • Immediately leaves gluteal region by crossing sacrospinous ligament and passing through lesser sciatic foramen
174
Q

Describe the course of the femoral artery

A
  1. Continuation of external iliac inferior to inguinal ligament
  2. Bisects femoral triangle
  3. Courses through adductor canal
  4. Becomes popliteal artery as it traverses adductor hiatus
175
Q

Origin of Profunda femoris artery

A

Femoral artery, 1-5cm inferior to inguinal ligament

176
Q

Course of Profunda femoris artery

A
  1. Passes deep between pectineus and adductor longus

2. Descends on posterior to adductor longus on medial side

177
Q

How many perforating arteries arise from Profunda femoris to supply the posterior and posteromedial thigh

A

3

178
Q

Origin of medial and lateral circumflex femoral arteries

A

Profunda femoris or femoral artery

179
Q

Surface marker for femoral artery

A

Mid-inguinal point

180
Q

Course of the obturator artery

A
  1. Passes through obturator foramen
  2. Enters medial compartment of thigh
  3. Divides into anterior and posterior branches which pass on either side of adductor brevis
181
Q

Distribution of the obturator artery

A
  • Anterior branch = obturator externus, pectineus, adductors, gracilis
  • Posterior branch = muscles attached to ischial tuberosity
182
Q

Describe the course of the popliteal artery

A
  1. Continuation of femoral artery at adductor hiatus
  2. Passes through popliteal fossa
  3. Ends at lower border of popliteus
  4. Divides into anterior and posterior tibial arteries
183
Q

Describe the course of the anterior tibial artery

A
  1. Arises from popliteal artery
  2. Passes between tib and fib into anterior compartment
  3. Descends on IO membrane between TA and EDL
  4. Continue as dorsalis pedis
184
Q

Describe the course of the posterior tibial artery

A
  1. Arises from popliteal artery
  2. Passes through posterior compartment of leg
  3. Terminates distal to flexor retinaculum
  4. Splits into medial and lateral plantar arteries
185
Q

Describe the course of the great (long) saphenous vein

A
  1. Commences on medial side of dorsal venous arch
  2. Ascends immediately in front of medial malleolus
  3. Accompanied by saphenous nerve
  4. Ascends obliquely up medial aspect of thigh
  5. Drains into femoral vein at saphenous opening
186
Q

Surface marker for sapheno-femoral junction

A

4cm inferolateral to pubic tubercle

187
Q

Describe the course of the small (short) saphenous vein

A
  1. Commences on lateral side of dorsal venous arch
  2. Passes behind lateral malleolus
  3. Perforates deep fascia over popliteal fossa to enter popliteal vein
188
Q

What structure accompanies the short saphenous vein

A

Sural nerve

189
Q

What constitutes the sacral plexus

A

Anterior rami of L4-S4

190
Q

List the branches of the sacral plexus

A
  1. Sciatic
  2. Superior gluteal
  3. Nerve to quadratus femoris
  4. Inferior gluteal
  5. Nerve to obturator internus
  6. Nerve to piriformis
  7. Posterior cutaneous nerve of the thigh
  8. Perforating cutaneous
  9. Pudendal
  10. Pelvic splanchnic
  11. Nerves to levator ani and coccygeus
191
Q

Origin of sciatic nerve

A

L4-S3

192
Q

Describe the course of the pudendal nerve

A
  1. Originates from S2-4
  2. Leaves pelvis via greater sciatic foramen with pudendal artery
  3. Hooks around ischial spine and sacrospinous ligament to enter perineum via lesser sciatic foramen
193
Q

List the branches of the sciatic nerve

A
  1. Muscular
  2. Tibial
  3. Common peroneal
194
Q

Distribution of sciatic nerve

A
  • Muscular branch = biceps femoris, semimembranosus, semitendinosus, hamstring part of adductor magnus
  • Cutaneous = posterior thigh (via cutaneous branches), gluteal region, entire lower leg except medial aspect
195
Q

Origin of the lumbar plexus

A

L1-4

196
Q

Where is the lumbar plexus formed

A

On the substance of psoas major

197
Q

List the branches of the lumbar plexus

A
  • Femoral nerve
  • Obturator nerve
  • Ilioinguinal nerve
  • Iliohypogastric
  • Lateral cutaneous nerve of the thigh
  • Genitofemoral nerve
198
Q

List the branches of the femoral nerve

A
  • Quadriceps
  • Sartorius
  • Pectineus
  • Medial cutaneous nerve of thigh
  • Intermediate cutaneous nerve of thigh
  • Saphenous nerve
  • Articular branches to hip and knee
199
Q

Where is the lumbosacral trunk situated

A

Anterior to piriformis and under common iliac

200
Q

Course and distribution of saphenous nerve

A
  • Branch of femoral
  • Descends with femoral vessels through femoral triangle and adductor canal
  • Skin on medial side of ankle and foot
201
Q

Course and distribution of sural nerve

A
  • Branch of tibial and common peroneal
  • Descends between heads of gastroc, then with small saphenous vein, passes inferior to lateral malleolus
  • Skin on posterior and lateral aspect of leg and foot
202
Q

Course and distribution of tibial nerve

A
  • Branch of sciatic
  • Forms at apex of pop fossa, lies on popliteus, descends with posterior tibial vessels and crosses artery 2.5cm from its origin to run on medial side of it, terminates under flexor retinaculum
  • Posterior muscles of leg and knee joint
203
Q

Course and distribution of common peroneal nerve

A
  • Branch of sciatic
  • Forms at apex of pop fossa, follows medial border of biceps femoris, passes over posterior aspect of fibula head and winds around neck
  • Supplies lateral posterior aspect of leg via lateral cutaneous nerve and knee via articular branch
204
Q

Course and distribution of superficial peroneal nerve

A
  • Branch of common peroneal
  • Arises between peroneus longus and neck of fibula, descends in lateral compartment, pierces deep fascia in distal 1/3rd to become subcutaneous
  • Peroneus longus and brevis, skin on distal 1/3rd of anterior surface of leg and dorsum of foot
205
Q

Course and distribution of deep peroneal nerve

A
  • Branch of common peroneal
  • Arises between peroneus longus and head of fibula, passes through EDL and on IO membrane, crosses distal end of tibia to enter dorsum of foot
  • Anterior muscles of leg, dorsum of foot, skin of 1st and 2nd webspace, articular branches to joints it crosses
206
Q

When is the head of the femur and acetabulum most congruent

A
  • Hip flexed 90
  • Abducted 5
  • LR 10
207
Q

Attachments of the hip capsule

A
  • Proximal = acetabulum, transverse acetabular notch, transverse ligament
  • Distal = intertrochanteric line, base of GT/LT, posterior to femoral neck
208
Q

List the 3 intrinsic ligaments of the hip joint

A
  1. Iliofemoral (anterior and superior
  2. Pubofemoral (anterior and inferior)
  3. Ischiofemoral (posterior)
209
Q

Course of the iliofemoral ligament

A

Anterior inferior iliac spine to trochanteric line (inverted Y-shape)

210
Q

Outline the blood supply to the hip joint

A
  • Medial and lateral circumflex femoral arteries (branches of profunda femoris)
  • Artery of head of femur (branch of obturator artery)
211
Q

What structure is at risk during posterior hip dislocation

A

Sciatic nerve

212
Q

Outline the lateral approach to the hip

A
  1. Split fibres of TFL, gluteus medius and minimus

2. Divide transverse branch of lateral circumflex femoral artery

213
Q

Outline the anterior approach to the hip

A
  1. Between gluteus medius and minimis lateraly and sartorius medially
  2. Reflected head of rectus femoris is divided to expose anterior aspect of joint
214
Q

Outline the posterior approach to the hip joint

A
  1. Through angled incision commencing and posterior superior iliac spine and passing across GT
  2. Gluteus maximus is split along the line of its fibres
  3. Gluteus medius and minimis are detached from their insertion at GT
215
Q

List the joint compartments of the knee

A
  1. Tibiofemoral

2. Patellofemoral

216
Q

Outline the attachments of the knee joint capsule

A
  • Superior = femur
  • Posterior = fibrous layer encloses condyles and intercondylar fossa
  • Inferior = margins of tibial plateau (except where popliteus tendon crosses bone)
  • Anterior = blends with tendons of vastus medialis and lateralis
217
Q

Describe the course of the medial collateral ligament and its attachments

A
  • Passes from medial epicondyle of femur to tibia

- Posterior fibres are attached to medial meniscus

218
Q

Describe the course of the lateral collateral ligament

A
  • Passes from lateral epicondyle of femur to head of fibula

- It is free from the capsule

219
Q

Describe the course and function of the anterior cruciate ligament

A
  • From the front of the intercondylar area of the tibia up to the intercondylar notch of femur
  • Resists forward displacement of the tibia on femur
  • Taught in hyperextension
220
Q

What crosses the lateral meniscus

A

Popliteus tendon

221
Q

Ligamentous support of the medial longitudinal arch of the foot

A
  • Spring ligament

- Interosseous ligaments (including deltoid ligament)

222
Q

What separates the PCL from the popliteal vessels

A

Oblique popliteal ligament

223
Q

What muscle supports the transverse arch of the foot

A

Peroneus longus

224
Q

Which ligaments support the lateral longitudinal arch of the foot

A
  • Short plantar ligament

- Long plantar ligament

225
Q

How many muscle layers make up the sole of the foot

A

4

Musculoskeletal (5 decks)

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